Culture of Evidence? What Science Has and Hasn’t Told Us About a Workplace Culture of Health

StayWell Blog, StayWell News

By Stefan Gingerich, MS, StayWell’s senior research analyst

Last week wellness (well-being?) professionals from around the globe gathered at the RiverCentre in St. Paul, Minnesota to attend the 42nd Annual National Wellness Conference. I had the honor of presenting a breakout session called “Culture of Evidence? What Science Has and Hasn’t Told Us About a Workplace Culture of Health” in which I reviewed the findings of a whole lot of peer-reviewed evidence related to the topic of “culture of health”. Since you may not have been able to attend, here’s what I asked the attendees to learn from my session, if they learned nothing else.

  1. There are many definitions of “culture of health” and each has strengths and weaknesses.
  2. For many reasons the science behind what we know about a culture of health has opportunity for improvement. Among the reasons: too many definitions, lack of time-over-time studies, gaps in culture measurement.
  3. We have very strong theoretical and anecdotal reasons to believe the concept of a culture of health is vital to employee health, and many studies back these theories up.
  4. Knowledge and learning are continuous, ever-evolving things. There is much to be studied, gaps to be filled, and there are a number of efforts underway to address them.

So there. Now you’ve read the Cliff’s Notes summary of one session. But the conference offered so much more. It was refreshing in one very important way: people who attend this conference are open and almost eager to change their mind and learn new things.

Too often I see examples of people who do not change their viewpoint when presented with new information. This is not to say that every piece of new information should change one’s mind. But a rational person should balance what they already know with what they learn, and make a reasonable conclusion. Would the bullet points above change your mind about what you currently think about a workplace culture of health?

The seed out of which my presentation grew was a 2012 paper co-authored by StayWell’s own David Andersen, and lead-authored by Dr. Steven Aldana, titled “A Review of the Knowledge Base on Healthy Worksite Culture”. In particular, I was surprised by this statement below from the article.

“There is some evidence that best practice worksite HPPs incorporate more cultural elements in their strategies and result in a reduction of employee health risks by as much as 5% per year, a level 2.5 times as much as standard practice programs. This is notable because we know that reducing employee risk by as little as 0.1% to 0.2% per year can result in breakeven for the wellness program investment. Outside of these studies, there is little published evidence that directly supports the association between a worksite culture of health and improved health risks.”

When I read this I was surprised because I had previously thought there was a fair amount of published evidence to support the link between a worksite culture of health and improved health risks. Since the paper was 3 or 4 years old at the time, I decided to look around for more recent published evidence. There have been some studies published since the Aldana review and they are good studies (References listed at the end of the blog). Still, I learned that there’s opportunity for a lot more research in this area, and I wondered if the people who attended my session at the National Wellness Conference would have a similar experience.

So, I asked them.

Before the presentation, each person in the audience was asked how clear or vague they thought the definition of “culture of health” was. They wrote their responses on a notecard. They were asked the same question after the presentation, and they wrote their responses on the same notecard. Not everyone participated; I got about 50% of the cards back.

For this question you can see a net 3-person shift from “very vague” to “vague”, suggesting that during the presentation the clarity of the definition of culture of health was improved. So that’s good. More people feel a little better about the definition.

What you can’t see in this picture is that 9 out of the 18 people changed their mind. Some changed from “clear” to “vague” or vice versa, others changed from “very vague” to “vague”.

I also asked everyone how strong or weak they felt the evidence was that changing a worksite culture of health would improve health risks or outcomes of employees. Here’s how they responded.

There appears to be more movement here, with a sort of parting of the seas. One more person said “strong”, but 2 more people said “somewhat weak” from before and after the presentation.

What do we make of this? When presented with the same information, these people drew different conclusions. And what’s really interesting is that for this question 28% of people changed their mind. A large majority didn’t, but those who did changed in opposite directions.

My conclusion? People are unpredictable. It’s not terribly insightful but I think it’s true. Perhaps more insightful is how we apply it to the science of a culture of health. As StayWell works to fill the gaps in what we know about workplace well-being programs, we and our clients will have to be diligent about studying, learning, and applying what we know, understanding that others may not see things the same way we see them. Even if we’re all looking at the same information.

To learn more about culture and well-being, contact us at

In good health,

Hoebbel C, et al. Associations between the worksite environment and perceived health culture. AJHP 2012. 26(5):301-304.

Kolbe-Alexander T, et al. The relationship between workplace environment and employee health behaviors in a South African workforce. JOEM 2014. 56(10):1094-1099.

Kwon Y, Marzec M. Does worksite culture of health (CoH) matter to employees? Empirical evidence using job-related metrics. JOEM 2016. 58(5):448-454.

Melnyk B, et al. Relationships among perceived wellness culture, healthy lifestyle beliefs, and healthy behaviors in university faculty and staff: Implications for practice and future research. W Jour Nurs Res 2016. 38(3):308-324.

Terry P, et al. Analyzing best practices in employee health management: How age, sex, and program components related to employee engagement and health outcomes. JOEM. 2013. 55(4):378-392.